What could be the reason for my acid reflux issues at 46?

Question

Hello doctor,

I am a 46-year-old man who has struggled with acid reflux for over five years. Even though I have been on Pantoprazole twice daily and made lifestyle changes like avoiding late meals, I still wake up at night with heartburn and sometimes a bitter taste. Recently, I have noticed occasional hoarseness and mild chest discomfort. Please tell me;

Could this be laryngopharyngeal reflux or a hiatal hernia?
Should I undergo an upper endoscopy or pH (power of hydrogen) monitoring to get clarity?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Given your history of long-standing acid reflux that has not responded fully to twice-daily Pantoprazole and lifestyle measures, your situation warrants further evaluation. Persistent reflux symptoms despite optimal proton pump inhibitor (PPI) therapy can point toward complications such as laryngopharyngeal reflux (LPR), where acid reaches the throat and voice box.

This causes the following symptoms, like

Hoarseness.
Cough, or throat irritation.
A hiatal hernia can mechanically worsen reflux by allowing part of the stomach to slide into the chest.

The bitter taste and nocturnal symptoms also suggest ongoing acid exposure. In such cases, an upper endoscopy (esophagogastroduodenoscopy, EGD) is usually recommended to look for esophagitis, Barrett’s esophagus, or a hiatal hernia.

If the endoscopy does not show clear signs, then ambulatory pH (power of hydrogen) monitoring (with or without impedance testing) is the gold standard to confirm abnormal acid exposure and correlate it with your symptoms.

Given your hoarseness and chest discomfort, it is important not only to assess for reflux-related damage but also to rule out other causes, including cardiac issues.

So an upper endoscopy would be a reasonable next step, and if it is inconclusive, pH monitoring can provide clarity on whether your ongoing symptoms are due to acid reflux or another condition.

I hope this information helps you.

Feel free to ask further queries.

Thank you.